Well Baby Care

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WELL BABY CARE

The Centers for Disease Control and Prevention (CDC) estimates that about 17% of children under age 18 have a developmental or behavioral disability, such as autism or attention-deficit/hyperactivity disorder. However, fewer than 50% of these children are identified by the health care system as having these problems before they start school. Once children are in school, it’s much more expensive to identify, address, and manage the educational needs of children with developmental disabilities.

The Individuals with Disabilities Education Act (IDEA) Amendments of 1990 to 1997 require states to provide early identification and provision of services to infants and toddlers with 1) developmental delays, 2) established conditions that are associated with developmental delays, and, 3) at the state’s option, children at risk for developmental delays. Yet there is no currently available delivery system for these services to take place during the infancy period.

What We Know

After birth or adoption there is little governmental support for well baby care. Children with incomplete well baby care are 60% more likely to visit an emergency department compared to children whose care is up-to-date.

Among children ages 0–15, Vistnes and Hamilton (1995) found that the number of well visits a child receives decreases as mother’s hours worked per week and weeks worked per year increase. Reference: Vistnes, J. P., & Hamilton, V. (1995). The time and monetary costs of outpatient care for children. The American Economic Review, 85, 117–121.

In high- risk or chronically ill children, lack of well baby care increases the likelihood of preventable hospitalization.

Preterm infants who survive birth are at greater risk of developing both short- and long-term health complications including cerebral palsy, sensorial and motor disabilities, respiratory illnesses and learning and behavioral disorders. Many of the debilitating effects of these health issues can be prevented with well baby care.

Many European countries provide universal nurse home visitation services for all newborns and their families. By comparison, the U.S. provides home visitation services just to a fraction of those at-risk populations that qualify for services.

Berger et al. (2005) found that mothers who return to work early (within the first 12 weeks after giving birth) are 2.4% points less likely to take their babies for any well baby care in the first year of life and their babies receive 0.20 fewer visits on average. Reference: Berger, L. M., Hill, J., & Waldfogel, J. (2005). Maternity leave, early maternal employment and child health and development in the US. The Economic Journal, 115, F29–F47.

Only 20% of physicians routinely use developmental screening tests. Factors that contribute to the low rates of routine screening include a perceived lack of time, with the average well-child visit lasting less than 20 minutes; limited reimbursement for using validated screening tools, which providers must pay a fee to use; and necessary changes to a practice’s workflow to implement standardized screening. References:
Glascoe, F.P. (1999). The value of parents’ concerns to detect and address developmental and behavioural problems. Journal of Pediatric Child Health, 35, 1-8.
Dobrez, D., Lo Sasso, A., Holl, J., Shalowitz, M., Leon, S., & Budetti, P. (2001). Estimating the Cost of Developmental and Behavioral Screening of Preschool Children in General Pediatric Practice. Pediatrics, 4.

Assistance with breast-feeding to help mothers continue the practice is a common component of well baby home visiting services.

Recommendations

The American Academy of Pediatrics (AAP) recommends children receive six well baby visits by age 12 months, in addition to a newborn and a 3–5 day follow-up visit after hospital discharge. However, fewer than 10% of infants meet recommendations. Reference: Committee on Practice and Ambulatory Medicine, Bright Futures Steering Committee. (2007). Recommendations for preventive pediatric health care. Pediatrics, 120, 1376.

Well baby visits should include health screenings. Early diagnosis of existing conditions can improve prognosis. For example, children who receive screening for strabismus (commonly known as ‘‘lazy eye’’) or other sources of limited visual acuity (amblyomia) and are diagnosed before age 3 years have better long run visual acuity than children diagnosed at age 3 years. Similarly, infants who are diagnosed with congenital hearing loss have a higher likelihood of developing speech than those whose hearing loss goes undetected in infancy. References:
Williams, C. K. N., Harrad, R. A., Sparrow, J. M., & Harvey, I. (2002). Amblyopia treatment outcomes after screening before or at age 3 years: Follow up from randomized trial. British Medical Journal, 324, 1549–1551.)
Daw, N. W. (1998). Critical periods and amblyopia. Archives of Ophthalmology,116, 502–505.
Kaye, C. I. (2006). Newborn screening fact sheets. Pediatrics, 118, 934–963.

In 2003, 8.9% of infant deaths that occurred after the perinatal period and were not associated with congenital abnormalities were the result of infectious, endocrine, nutritional, or metabolic diseases. Most well baby home visits include screenings for many of these conditions, and routine physical examinations that aid early diagnosis and treatment. For some, treatment can be as simple as administering vitamin supplements and maintaining routine follow-up care. For others, readily available vaccines could be recommended for many infectious diseases. Reference: Hoyert, D. L., Kung, H., & Smith, B. L. (2005). Deaths: Preliminary data for 2003. National Vital Statistics Reports, 53, 15.